In a decade-long study of 108 adults living with stage 3 chronic kidney disease, a quiet question about how the body handles acid has been placed beside an ordinary kitchen answer. Some participants were asked to eat more fruits and vegetables, others were given the standard sodium bicarbonate, and others simply continued their usual care. Those who ate the produce appeared to spend less time in hospitals, emergency rooms and on the path toward dialysis, while the medicine showed no clear advantage over doing nothing extra. The findings are a careful look back at results rather than a proven n
Fruits and Vegetables May Outperform Sodium Bicarbonate in Slowing Kidney Disease Progression
Over 10 years, 34 participants needed dialysis, and there were 115 hospitalizations and 166 emergency department visits during follow-up.
Sodium bicarbonate showed no difference from usual care
Mark
So what's the headline here? Fruit and vegetables beat the standard drug?
Mimi
On these measures, yes. Compared with usual care, the fruit and vegetable group had 14 hospitalizations versus 64, and 4 people reaching dialysis versus 16.
Mark
And the bicarbonate group?
Mimi
No difference from usual care on hospitalizations, emergency visits or dialysis. That's the surprising part, since bicarbonate is the standard treatment.
Mark
Both arms were meant to cut dietary acid in half, right?
Mimi
Right. Same target, different method, which makes the contrast more interesting.
Luke
I'd slow down on the word "outperform." It's 36 people per arm, and this is a post hoc analysis of a trial, so these outcomes weren't necessarily what it was originally built to test.
Mark
Does that make the numbers unreliable?
Luke
Not necessarily, but it makes them hypothesis-strengthening rather than conclusive. The source doesn't give confidence intervals or say whether the differences were statistically tested.
Mimi
The cost claim is also the authors' own. Goraya says costs weren't increased overall, but the summary gives no cost figures.
Luke
Exactly. And it's a conference presentation, so it hasn't necessarily gone through full peer review. A larger confirmatory trial would be needed before anyone changes practice.
Mark
So what should a reader take from it?
Mimi
That diet looks worth testing seriously in kidney disease, and that Kidney Week is where more detail will come out.
Il Polso
- Over ten years, a fruit and vegetable diet cut hospitalizations from 64 to 14 compared with usual care, a gap that stands out sharply against the rest of the data.
- Emergency department visits fell from 88 to 20 and dialysis progression from 16 to 4, challenging the assumption that the standard treatment is the strongest option.
- Sodium bicarbonate performed no differently from usual care on any of the measured outcomes, leaving the established therapy's value in this setting open to question.
- The results come from a post hoc analysis, so researchers must now confirm them in larger trials before any guideline could shift.
- Findings will be shared at ASN Kidney Week 2026, where clinicians and researchers will look for the details that could decide whether diet becomes a recognized kidney therapy.
In a decade-long study of 108 adults living with stage 3 chronic kidney disease, a quiet question about how the body handles acid has been placed beside an ordinary kitchen answer. Some participants were asked to eat more fruits and vegetables, others were given the standard sodium bicarbonate, and others simply continued their usual care. Those who ate the produce appeared to spend less time in hospitals, emergency rooms and on the path toward dialysis, while the medicine showed no clear advantage over doing nothing extra. The findings are a careful look back at results rather than a proven new rule, and they invite the wider medical world to test whether the plate itself can be a form of treatment.
Thirty-six people were asked to eat more fruits and vegetables, thirty-six were given sodium bicarbonate, and thirty-six continued with usual care. All 108 had stage 3 chronic kidney disease and metabolic acidosis, the condition in which too much acid builds up in the body. They were followed once a year for ten years.
Sodium bicarbonate is a standard treatment for this problem, but the trial tested it against a different route: base-producing fruits and vegetables, chosen to cut dietary acid by half. The bicarbonate group was aimed at the same halving, so both approaches were judged against the same target, reached by different paths.
The differences were striking. Compared with usual care, the produce group had 14 hospitalizations against 64, 20 emergency visits against 88, and 4 people progressing to dialysis against 16. Sodium bicarbonate showed no difference from usual care on any of these measures.
The lead author, Nimrit Goraya of Baylor Scott and White Health, said the fruit and vegetable approach led to better long-term outcomes and lower health care use, without raising overall costs. She suggested such dietary interventions deserve evaluation both for individual patients and at the population level.
The analysis was conducted after the trial design was set, so it is a post hoc look rather than a confirmed conclusion. Larger confirmatory studies would likely be needed before guidelines change, and the detailed presentation at ASN Kidney Week will be the next place to see how the evidence holds.
Thirty-six people were assigned to eat more fruits and vegetables. Thirty-six were given sodium bicarbonate. Thirty-six got usual care. All 108 were adults with stage 3 chronic kidney disease and metabolic acidosis, a buildup of too much acid in the body, and they were followed once a year for a decade. The results of that trial will be presented at ASN Kidney Week 2026, running October 22 to 25.
Oral sodium bicarbonate is a standard treatment for metabolic acidosis in people with chronic kidney disease. The trial tested it against a different approach: base-producing fruits and vegetables, used to bring dietary acid down by half. The bicarbonate group was also aimed at cutting dietary acid by half, so the two treatments were set to the same target by different routes.
Over the follow-up period, the participants accumulated 115 hospitalizations and 166 emergency department visits, and 34 of them needed dialysis. Those totals were not spread evenly across the groups.
Compared with usual care, the fruits and vegetables group had 14 hospitalizations against 64. It had 20 emergency department visits against 88. And 4 people in that group progressed to dialysis, compared with 16 in the usual care group. Sodium bicarbonate, by contrast, did not differ from usual care on any of those three measures.
The corresponding author, Nimrit Goraya, MD, of Baylor Scott and White Health, said treating metabolic acidosis with fruits and vegetables was associated with more favorable long-term clinical outcomes and health care use than either sodium bicarbonate or usual care. She said this came without increasing overall health-system or societal costs.
Goraya argued that the findings support evaluating dietary interventions in kidney disease at the population level as well as for individual patients, where the cumulative clinical and economic benefits may be substantial. She also pointed to the potential quality-of-life and health-system value of investing in fruits and vegetables as a treatment, particularly when good outcomes do not raise costs.
The work is titled "Long-Term Outcomes and Health Care Costs of Fruits and Vegetables vs. Sodium Bicarbonate or Usual Care for Metabolic Acidosis in CKD: Post Hoc Analysis of a 10-Year Randomized Trial." The words post hoc matter: the analysis looked at these outcomes and costs after the trial design was set. Larger confirmatory trials would likely be needed before any guideline changes, and the Kidney Week presentation is the next place to watch for more detail.
Citazioni salienti
Treating metabolic acidosis with fruits and vegetables was associated with more favorable long-term outcomes and health care use than sodium bicarbonate or usual care, without raising overall costs.— Nimrit Goraya, MD, Baylor Scott and White Health (paraphrased)
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